Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1223 - OUTPATIENT DRUG AND ALCOHOL CLINIC SERVICES
PROVIDER PARTICIPATION
Section 1223.41 - Participation requirements

(1) Be fully or provisionally licensed/approved as an outpatient drug/alcohol facility by the Department of Health. To remain eligible for Medical Assistance reimbursement, a facility shall be fully or provisionally licensed/approved at all times as an outpatient drug/alcohol clinic.

(2) Have medical personnel currently licensed or registered in accordance with the laws of the Commonwealth.

(3) Have a written patient referral plan that provides for inpatient hospital care and other follow-up treatment.

(4) Post a current, written fee schedule for billing third party and private payors.

(5) Appoint an administrator or director responsible for the internal operation of the clinic in accordance with established policies. Appoint a physician responsible for the supervision and direction of services rendered to eligible recipients.

(6) Notify immediately the Department's Office of Medical Assistance Programs, in writing, of any facility name, address and service changes prior to the effective date of change. Failure to do so may result in payment interruptions or termination of the provider agreement.

(7) Enter into a written provider agreement with the Department.

(8) Forward copies of items required by subparagraphs (i)-(v) to the Office of Medical Assistance Programs. It is the clinic director's responsibility to notify the Office of Medical Assistance Programs, in writing, of changes in the clinic's full compliance with licensure standards and changes in the following items required by subparagraphs (i)-(v) within 30 days following a change. If the clinic is relicensed by the Department of Health, the clinic director shall also forward a copy of the current license to the Office of Medical Assistance Programs within 30 days of relicensure:

(9) Have each branch location or satellite of an approved clinic also licensed by the Department of Health as an outpatient clinic and be approved by the Office of Medical Assistance Programs before reimbursement can be made for services rendered at the branch or satellite. Approval of the parent organization does not constitute approval for any branches or satellites of the same organization.

(10) Be approved by the Office of Medical Assistance Programs.

(11) Ensure that a DAAP performs a level of care assessment for each patient prior to admission to the clinic and the provision of treatment.